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IF01. First Million Men Screened in the NHS Abdominal Aortic Aneurysm Screening Programme in England
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S
VESS27. VESS27 Extrathoracic Vascular Manifestations in Connective Tissue Disorder Patients: A 10-Year Single-Center Experience Bryan Ehlert, MD1, Caitlin W. Hicks, MD, MS2, Jennifer Lue, BS3, Robert J. Beaulieu, MD2, James H. Black III, MD, FACS2. 1Johns Hopkins Hospital, Baltimore, Md; 2Johns Hopkins University, Baltimore, Md; 3 University of Maryland School of Medicine, Baltimore, Md Objectives: Ascending and thoracic aortic dissections and aneurysms are common vascular complications in patients with connective tissue disorders (CTD). CTD patients may also present with extrathoracic manifestations of their disorder; however, this pattern of disease and results of surgery have not been reported. The purpose of this study was to report the largest contemporary analysis of extrathoracic arterial disease in CTD patients and surgical outcomes in this unique vascular surgery population. Methods: Retrospective review of operative records from a single center was conducted to identify all CTD patients undergoing arterial reconstructions over a 10-year period. Patients with known Marfan syndrome (MFS), vascular Ehlers-Danlos syndrome (vEDS), Loeys-Dietz syndrome (LDS) and familial thoracic aortic aneurysm and dissection syndrome (FTAAD) accounted for our patient population. For statistical analysis, patients were further stratified into MFS and non-MFS cohorts. Patients undergoing reconstruction of the ascending, descending thoracic or thoracoabdominal aorta were excluded from the study. Univariate analysis was performed on the two cohorts evaluating demographics, anatomic factors and surgical outcomes. Results: A total of 47 arteries in 25 CTD patients (25 arteries in 14 MFS patients, 22 arteries in 11 non-MFS patients) met inclusion criteria. MFS patients were younger than the non-MFS group at the time of surgery, 41.9 6 2.8 vs 53.3 6 3.0 years (P ¼ .01). Iliac and infrarenal aortic reconstructions were most prominent, 40% and 26%, respectively, distributed evenly among both cohorts. Non-MFS patients had a higher incidence of popliteal aneurysms with 18% vs 0% (P ¼ .04). MFS patients were more likely to have a history of thoracoabdominal aneurysm repair (72% vs 32%; P ¼ .01) and prior emergency dissection repairs (48% vs 9%; P < .01). In non-MFS patients, extrathoracic pathology was not associated with prior emergency dissection repair (P ¼ 1.0). MFS patients underwent more open repairs over endovascular procedures than non-MFS patients (92% vs 68%; P ¼ .04). There were no perioperative mortalities, a 20% morbidity rate, and 100% survival over a median follow-up of 32 months (interquartile range, 12-60). Conclusions: Our study suggests extrathoracic manifestations of CTD occur not infrequently. CTD patients tolerate both open and endovascular therapies for peripheral arterial pathology with durable long-term results. While the cardinal manifestation of CTD may be initial aortic root aneurysm or type A dissection, vascular surgeons should consider genetic evaluation for all CTD types when confronted by extrathoracic aneurysms or dissections in the young patient. Furthermore, surveillance for CTD
Abstracts 35S
patients should include complete body imaging as extrathoracic pathology may occur independently of prior cardioaortic event. Author Disclosures: R. J. Beaulieu: Nothing to disclose; J. H. Black: Cook Medical: consulting fees (eg, advisory boards); B. Ehlert: Nothing to disclose; C. W. Hicks: Nothing to disclose; J. Lue: Nothing to disclose. C1: International Forum IF01. First Million Men Screened in the NHS Abdominal Aortic Aneurysm Screening Programme in England Jonothan Earnshaw, FRCS, MBBS1, Clare Oliver Williams, MBBS2, Tim Lees, FRCS, MBBS3, Jo Jacomelli, PhD4, Lisa J. Summers, RN4, Anne Stevenson, PhD4, Michael Sweeting, PhD2, Simon Thompson, PhD, MBBS2. 1Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom; 2 Cambridge University Hospitals, Cambridge, United Kingdom; 3Newcastle University Hospitals, Newcastle, United Kingdom; 4Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom Objectives: The NHS AAA Screening Programme (NAAASP) commenced in England in 2009 and has been fully operational since 2013. Each year, w300,000 men aged 65 years old are invited for an ultrasound scan to look for abdominal aortic aneurysm (AAA). The aim of the present study was to examine the results of screening and the safety of men in surveillance. Methods: The results of AAA screening are maintained on a bespoke call-recall IT system (AAA SMaRT). This was interrogated for the results in January 2016. Results: Some 1.3 million 65-year old men were invited for screening since 2009; 1,019,480 were scanned (uptake 79.5%). The prevalence of an AAA >2.9 cm diameter was 1.3% (falling from 1.7% in 2009 and 2010 to 1.1% in 2015). A total of 11,972 men had small (3-4.5 cm) or medium (4.5-5.4 cm) AAAs and were monitored in surveillance, with 13 deaths from AAA rupture. Some 1025 men with initial aortic diameter >5.4 cm, and a further 898 men whose AAA grew in surveillance were referred for consideration of elective AAA repair. Mortality in electively treated men was 0.91%. Conclusions: Although the prevalence of AAA in 65year-old men is lower than expected and may be falling, the NAAASP remains cost-effective and is finding large numbers of AAA. It remains on course to prevent up to half of deaths from ruptured AAA by the end of the decade. Sponsor: Dr Ali AbuRhahma, Charleston West Virginia. Author Disclosures: J. Earnshaw: Nothing to disclose; J. Jacomelli: Nothing to disclose; T. Lees: Nothing to disclose; C. Oliver Williams: Nothing to disclose; A. Stevenson: Nothing to disclose; L. J. Summers: Nothing to disclose; M. Sweeting: Nothing to disclose; S. Thompson: Nothing to disclose.
VESS27. VESS27 Extrathoracic Vascular Manifestations in Connective Tissue Disorder Patients: A 10-Year Single-Center Experience Bryan Ehlert, MD1, Caitlin W. Hicks, MD, MS2, Jennifer Lue, BS3, Robert J. Beaulieu, MD2, James H. Black III, MD, FACS2. 1Johns Hopkins Hospital, Baltimore, Md; 2Johns Hopkins University, Baltimore, Md; 3 University of Maryland School of Medicine, Baltimore, Md Objectives: Ascending and thoracic aortic dissections and aneurysms are common vascular complications in patients with connective tissue disorders (CTD). CTD patients may also present with extrathoracic manifestations of their disorder; however, this pattern of disease and results of surgery have not been reported. The purpose of this study was to report the largest contemporary analysis of extrathoracic arterial disease in CTD patients and surgical outcomes in this unique vascular surgery population. Methods: Retrospective review of operative records from a single center was conducted to identify all CTD patients undergoing arterial reconstructions over a 10-year period. Patients with known Marfan syndrome (MFS), vascular Ehlers-Danlos syndrome (vEDS), Loeys-Dietz syndrome (LDS) and familial thoracic aortic aneurysm and dissection syndrome (FTAAD) accounted for our patient population. For statistical analysis, patients were further stratified into MFS and non-MFS cohorts. Patients undergoing reconstruction of the ascending, descending thoracic or thoracoabdominal aorta were excluded from the study. Univariate analysis was performed on the two cohorts evaluating demographics, anatomic factors and surgical outcomes. Results: A total of 47 arteries in 25 CTD patients (25 arteries in 14 MFS patients, 22 arteries in 11 non-MFS patients) met inclusion criteria. MFS patients were younger than the non-MFS group at the time of surgery, 41.9 6 2.8 vs 53.3 6 3.0 years (P ¼ .01). Iliac and infrarenal aortic reconstructions were most prominent, 40% and 26%, respectively, distributed evenly among both cohorts. Non-MFS patients had a higher incidence of popliteal aneurysms with 18% vs 0% (P ¼ .04). MFS patients were more likely to have a history of thoracoabdominal aneurysm repair (72% vs 32%; P ¼ .01) and prior emergency dissection repairs (48% vs 9%; P < .01). In non-MFS patients, extrathoracic pathology was not associated with prior emergency dissection repair (P ¼ 1.0). MFS patients underwent more open repairs over endovascular procedures than non-MFS patients (92% vs 68%; P ¼ .04). There were no perioperative mortalities, a 20% morbidity rate, and 100% survival over a median follow-up of 32 months (interquartile range, 12-60). Conclusions: Our study suggests extrathoracic manifestations of CTD occur not infrequently. CTD patients tolerate both open and endovascular therapies for peripheral arterial pathology with durable long-term results. While the cardinal manifestation of CTD may be initial aortic root aneurysm or type A dissection, vascular surgeons should consider genetic evaluation for all CTD types when confronted by extrathoracic aneurysms or dissections in the young patient. Furthermore, surveillance for CTD
Abstracts 35S
patients should include complete body imaging as extrathoracic pathology may occur independently of prior cardioaortic event. Author Disclosures: R. J. Beaulieu: Nothing to disclose; J. H. Black: Cook Medical: consulting fees (eg, advisory boards); B. Ehlert: Nothing to disclose; C. W. Hicks: Nothing to disclose; J. Lue: Nothing to disclose. C1: International Forum IF01. First Million Men Screened in the NHS Abdominal Aortic Aneurysm Screening Programme in England Jonothan Earnshaw, FRCS, MBBS1, Clare Oliver Williams, MBBS2, Tim Lees, FRCS, MBBS3, Jo Jacomelli, PhD4, Lisa J. Summers, RN4, Anne Stevenson, PhD4, Michael Sweeting, PhD2, Simon Thompson, PhD, MBBS2. 1Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom; 2 Cambridge University Hospitals, Cambridge, United Kingdom; 3Newcastle University Hospitals, Newcastle, United Kingdom; 4Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom Objectives: The NHS AAA Screening Programme (NAAASP) commenced in England in 2009 and has been fully operational since 2013. Each year, w300,000 men aged 65 years old are invited for an ultrasound scan to look for abdominal aortic aneurysm (AAA). The aim of the present study was to examine the results of screening and the safety of men in surveillance. Methods: The results of AAA screening are maintained on a bespoke call-recall IT system (AAA SMaRT). This was interrogated for the results in January 2016. Results: Some 1.3 million 65-year old men were invited for screening since 2009; 1,019,480 were scanned (uptake 79.5%). The prevalence of an AAA >2.9 cm diameter was 1.3% (falling from 1.7% in 2009 and 2010 to 1.1% in 2015). A total of 11,972 men had small (3-4.5 cm) or medium (4.5-5.4 cm) AAAs and were monitored in surveillance, with 13 deaths from AAA rupture. Some 1025 men with initial aortic diameter >5.4 cm, and a further 898 men whose AAA grew in surveillance were referred for consideration of elective AAA repair. Mortality in electively treated men was 0.91%. Conclusions: Although the prevalence of AAA in 65year-old men is lower than expected and may be falling, the NAAASP remains cost-effective and is finding large numbers of AAA. It remains on course to prevent up to half of deaths from ruptured AAA by the end of the decade. Sponsor: Dr Ali AbuRhahma, Charleston West Virginia. Author Disclosures: J. Earnshaw: Nothing to disclose; J. Jacomelli: Nothing to disclose; T. Lees: Nothing to disclose; C. Oliver Williams: Nothing to disclose; A. Stevenson: Nothing to disclose; L. J. Summers: Nothing to disclose; M. Sweeting: Nothing to disclose; S. Thompson: Nothing to disclose.